Provider Demographics
NPI:1922781053
Name:LUNKWITZ, KELLY L (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:LUNKWITZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WAR TROPHY LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5245
Mailing Address - Country:US
Mailing Address - Phone:484-883-2411
Mailing Address - Fax:
Practice Address - Street 1:22 WAR TROPHY LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5245
Practice Address - Country:US
Practice Address - Phone:484-883-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA761012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse